In the current issue of P&P a report outlines the role of perfectionism in chronic fatigue and in other medical disturbances such as irritable bowel syndrome and fibromyalgia. Biopsychosocial models of chronic fatigue syndrome (CFS) posit that personality and stress have predisposing and perpetuating roles in the persistent and unexplained fatigue that characterizes this functional somatic syndrome. Studies indicate that many CFS patients are characterized by an achievement-oriented and perfectionist personality, and that such tendencies coupled with self-criticism drive these individuals to work beyond the point of exhaustion in a way that may initiate or perpetuate chronic fatigue. Although research indicates that CFS patients use maladaptive coping strategies more than healthy controls, it is unknown whether this is true relative to other chronic illness groups.

This study examined perfectionism dimensions and maladaptive coping styles in CFS patients compared with healthy controls and two other chronic illness groups. Participants were drawn from a larger sample of community-dwelling adults from the USA or Canada (n = 980) who completed an anonymous online survey on personality and health after providing informed consent. Authors selected individuals who indicated on a medical checklist that included 13 different chronic health conditions that they had been diagnosed by a medical professional with CFS, irritable bowel syndrome (IBS), or fibromyalgia (FM)/arthritis for 3 subsamples. The remaining participants were screened for the presence of other chronic diseases, leaving a final healthy sample of 564 subjects, which was divided into 6 random samples of comparable size to the illness groups, one of which was randomly chosen as the healthy control group.

Maladaptive perfectionism was significantly correlated with self-blame coping in both the CFS group and the healthy controls. The correlation between maladaptive perfectionism and behavioral disengagement coping was also significant for both group. However, these correlations did not differ significantly. Standards perfectionism was not significantly correlated with self-blame coping in the CFS group, but was negatively correlated in the healthy controls. The correlations with behavioral disengagement coping were negative in the CFS group and controls, but not significantly different. In the IBS group, maladaptive perfectionism was significantly correlated with each of the 4 maladaptive coping styles, whereas standards perfectionism negatively correlated with denial and behavioral disengagement. In the FM/arthritis group, maladaptive perfectionism was significantly correlated with all but substance use coping while standards perfectionism was not significantly correlated with any of the coping strategies.

Overall, these findings suggests that maladaptive perfectionism promotes self-critical thoughts that fuel a tendency to cope with stress by becoming consumed with self-blame rather than taking constructive action, a tendency that may be pronounced in the context of CFS, and that contributes to the prolonged chronic stress and subsequent allostatic crash posited by previous studies. Furthermore, they provide evidence that cognitive behavioral interventions that target perfectionism may help enhance the coping capacities of people with CFS.